Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Optical Coherence Tomography: A New Imaging Technique That Allows Detailed Visualization of Affected Scleroderma Skin.
Abignano1, Giuseppina, Aydin2, Sibel, Castillo-Gallego Jr.3, Concepcion, Buch1, Maya H., Emery4, Paul, Del Galdo1, Francesco
University of Leeds, Leeds, United Kingdom
Goztepe Training and Research Hospital, Istanbul, Turkey
Hospital Universitario La Paz, Madrid, Spain
NIHR-Leeds Biomedical Research Unit and Leeds Institute of Molecular Medicine, University of Leeds, Leeds, United Kingdom
Skin involvement in scleroderma is a crucial clinical feature often considered primary outcome in clinical trials and yet orphan of a validated and reliable imaging technique. Optical Coherence Tomography (OCT) is an emerging imaging technology for clinical examination. OCT systems focus a low-intensity infra-red beam in tissue up to 2 mm below the surface. While Ophthalmic OCT has been in development since the early 1990s, advanced laser technology and recent MultiBeam developments have recently enabled the development of high-speed topical OCT providing high-contrast skin mages. The purpose of this study was to describe skin appearances as seen with OCT and to compare these findings clinical assessment of skin in patient affected by Scleroderma.
Dorsal aspect of fingers, hands and forearm were assessed in this study. A total of 66 skin regions from 22 patients (9 lcSSc, 13 dc-SSC) and 12 healthy controls (HC) were scanned by OCT with topical probe "VivoSight" (Michelson Diagnostics) and optics of Swept-source Fourier-Domain type with a laser wavelength of 1305+/- 15 nm. The investigator was blinded to the clinical details.
Signal changes within epidermis, dermal epidermal junction and superficial dermis were documented. Clinical skin involvement of the regions examined was determined by an assessor blinded to the OCT findings using the mRSS scoring system.
OCT provided real-time, pain free, video-rated images without any pretreatment or gels applied to the skin. Skin structure was imaged 2mm beneath the surface.showed remarkably high quality images of the skin. Images collected in healthy volunteers showed, consistently with published findings a regular hyperreflective border of the skin surface and a homogeneous hypo-reflective epidermal layer. The papillary dermis consistently showed hyper-reflective properties compared to the adjacent epidermis allowing the visualization of the dermal-epidermal junction. The deeper reticular dermis was imaged as less reflective than the adjacent papillary dermis. Blood and lymphatic vessels could be identified as hypreflective tube-like structures, often with tapering ends and visible both in the papillary and reticular dermis.
Average mRSS on the site of analysis was 2.5 for dcSSc and 1 for lcSSc. (0 for healthy volunteers).
The most striking finding of Scleroderma affected skin was the loss of the hyporeflective epidermal layer and consequently of the visualization of the dermal epidermal junction. Similarly there was no distinction of papillary and reticular dermis. Instead skin was visualized as a homogeneous textured layer. Blood vessels were less numerous than in normal skin or unaffected skin.
This is a proof of concept study determining the potential of OCT as imaging technique of Scleroderma Skin. Here we show that OCT is indeed a powerful harmless technique that allows a finely detailed visualization of the skin. The implementation of a OCT scoring system of the abnormalities we have identified in this initial study is warranted to determined whether OCT could be used as surrogate outcome measure in intervention studies or as predictive of skin involvement in Systemic Sclerosis.
To cite this abstract, please use the following information:
Abignano, Giuseppina, Aydin, Sibel, Castillo-Gallego Jr., Concepcion, Buch, Maya H., Emery, Paul, Del Galdo, Francesco; Optical Coherence Tomography: A New Imaging Technique That Allows Detailed Visualization of Affected Scleroderma Skin. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :705